Our objective was to compare the pregnancy complications and neonatal outcomes of multifetal pregnancies reduced to twins to those in twin pregnancies without multifetal pregnancy reduction (MPR). A cohort study was performed in patients with dichorionic twin pregnancies who reached 24 weeks' gestation and delivered at the Mount Sinai Medical Center between 1986 and 1997. A study population of 77 multifetal pregnancies reduced to twins were compared with 140 dichorionic twin pregnancies without MPR regarding pregnancy complications and neonatal outcomes. Statistical analysis was performed with Chi-square and two-tailed Student's t-tests. Multifetal pregnancies reduced to twins were similar to nonreduced twins in all parameters studied except the cesarean section rate and neonatal polycythemia. Increased cesarean section rate in MPR group was attributed to elective indications. Pregnancy-induced hypertension was found to be higher only in a subgroup of patients (i.e., 4-2). Multifetal pregnancies reduced to twins do not differ from the twin pregnancies without MPR in the overwhelming majority of pregnancy complications and neonatal outcomes.